Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States
Objective The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis.
Study Design This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables.
Results Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17–1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50–1.93) when compared with those without a diagnosis of COVID-19.
Conclusion Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes.
Information about blood loss associated with peripartum COVID-19 is limited.
COVID-19 diagnosis is not associated with increase in obstetric hemorrhage.
COVID-19 diagnosis is not associated with increase in blood loss.
This study is approved by Boston University Institutional Reference Board (reference number: 1311956).
Received: 12 August 2020
Accepted: 07 September 2020
29 September 2020 (online)
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- 1 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
- 2 Dorgalaleh A. Bleeding and Bleeding Risk in COVID-19. Semin Thromb Hemost 2020
- 3 Al-Samkari H, Karp Leaf RS, Dzik WH. et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood 2020; 136 (04) 489-500
- 4 Vlachodimitropoulou Koumoutsea E, Vivanti AJ, Shehata N. et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost 2020; 18 (07) 1648-1652
- 5 Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150 (01) 53-57
- 6 Zhang L, Jiang Y, Wei M. et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi 2020; 55 (03) 166-171
- 7 Lyndon A, McNulty J, Vanderwal B. et al. Cumulative quantitative assessment of blood loss. California Maternal Quality Care Collaborative Obstetric Hemorrhage Toolkit Version 2.0. Available at: https://www.cmqcc.org/resource/ob-hem-cumulative-quantitative-assessment-blood-loss Accessed June 1, 2020
- 8 “Management of COVID-19.” National Institutes of Health, U.S. Department of Health and Human Services, Updated 11 June 2020. Available at: www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/ . Accessed August 22, 2020
- 9 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA 2020; 323 (13) 1239-1242
- 10 Rossi RM, DeFranco EA. Maternal complications associated with periviable birth. Obstet Gynecol 2018; 132 (01) 107-114
- 11 Kuper SG, Sievert RA, Steele R, Biggio JR, Tita AT, Harper LM. Maternal and neonatal outcomes in indicated preterm births based on the intended mode of delivery. Obstet Gynecol 2017; 130 (05) 1143-1151
- 12 Pierce-Williams RAM, Burd J, Felder L. et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM. 2020; 2 (03) 100134
- 13 Knight M, Bunch K, Vousden N. et al. UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
- 14 Kayem G, Lecarpentier E, Deruelle P. et al. A snapshot of the COVID-19 pandemic among pregnant women in France. J Gynecol Obstet Hum Reprod 2020; 49 (07) 101826
- 15 Martínez-Perez O, Vouga M, Cruz Melguizo S. et al. Association between mode of delivery among pregnant women with COVID-19 and maternal and neonatal outcomes in Spain. JAMA 2020; 324 (03) 296-299
- 16 Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol 2020; 7 (06) e438-e440
- 17 Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135 (23) 2033-2040
- 18 Benhamou D, Keita H, Ducloy-Bouthors AS. CARO working group. Coagulation changes and thromboembolic risk in COVID-19 obstetric patients. Anaesth Crit Care Pain Med 2020; 39 (03) 351-353
- 19 Gabel K, Lyndon A, Main E. OB hemorrhage risk factor assessment. California maternal quality care collaborative obstetric hemorrhage toolkit version 2.0. Available at: https://www.cmqcc.org/resource/ob-hem-risk-factor-assessment . Accessed June 01, 2020
- 20 Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19?. BMJ 2020; 369: m1548
- 21 Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID-19. N Engl J Med 2020; 382 (26) 2534-2543
- 22 Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010; 202 (04) 335-343
- 23 Abbas AM, Ahmed OA, Shaltout AS. COVID-19 and maternal pre-eclampsia: a synopsis. Scand J Immunol 2020; 92 (03) e12918
- 24 Gidlöf S, Savchenko J, Brune T, Josefsson H. COVID-19 in pregnancy with comorbidities: more liberal testing strategy is needed. Acta Obstet Gynecol Scand 2020; 99 (07) 948-949
- 25 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113 (08) 919-924
- 26 Della Torre M, Kilpatrick SJ, Hibbard JU. et al. Assessing preventability for obstetric hemorrhage. Am J Perinatol 2011; 28 (10) 753-760
- 27 Kerr RS, Weeks AD. Postpartum haemorrhage: a single definition is no longer enough. BJOG 2017; 124 (05) 723-726
- 28 Dahlke JD, Mendez-Figueroa H, Maggio L. et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (01) 76.e1-76.e10